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General NPI Number Information
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NPI Number | 1154912400
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Entity Type | Organization
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Legal Business Name | HEROIC LOVE INC
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Dates
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Enumeration Date | 01/29/2021
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 825 CANYON PL
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City | DESOTO
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State | TX
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Zip | 75115-6372
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Country | US
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Telephone | 214-236-8567
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Fax |
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Provider Business Mailing Address
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Address Line | 539 W COMMERCE ST STE 1113
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City | DALLAS
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State | TX
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Zip | 75208-1953
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Country | US
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Telephone | 214-236-8567
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | BRITTANY N MANNING
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Credential | LPC
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Telephone | 214-236-8567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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